Predicting successful prosthetic rehabilitation in major lower-limb amputation patients: a 15-year retrospective cohort study

Abstract

Regarding walking ability with or without walking aids, male gender and transtibial level of amputation are independently associated with failure and success respectively, whereas older age and comorbidities can predict failed prosthetic rehabilitation when assistive walking devices are considered. Future prospective cohort studies are needed to confirm these findings.

Factors Associated With Prolonged Length of Stay and Failed Lower Limb Prosthetic Fitting During Inpatient Rehabilitation

“…Physical factors in the LLAMS, specifically skin ulceration of the residual limb or the remaining foot, reduced the odds ratio for successful fitting to 0.23 and 0.25, respectively. This is consistent with previous findings 8 , 12 and warrants examination in individuals being considered for prosthetic fitting. Interventions that improve wound healing should be used to address these issues before initiation of prosthetic fitting.…”

“…Most Canadian inpatient rehabilitation facilities provide 4 to 9 weeks of prosthetic rehabilitation for individuals with BKA or AKA. 6 The failed prosthetic fitting rate was also high compared with reports from other countries 12 , 25 but similar to the rate (23.3%) reported by other Canadian facilities. 6 Although evidence from the United Kingdom and the United States support the delivery of inpatient rehabilitation for individuals with LLA leading to improved outcomes 26 , 27 and earlier achievement of rehabilitation milestones, 28 identifying and targeting factors that affect outcomes before admission could improve prosthetic candidate selection and improve the likelihood of success.…”

“…Sex was included as an independent variable, although the evidence regarding its effect on outcomes has been conflicting. 8 , 9 , 12 , 16 , 21 Time (in d) from surgery to rehabilitation admission was considered in the model, because earlier initiation of prosthetic rehabilitation has been associated with better outcomes. 12 , 21 …”

“… 7 , 8 Other potential predictors of poor prosthetic candidacy or limited walking ability include cognition or mood disturbances, poor balance, female sex, increased time from surgery to prosthetic rehabilitation, and limited social support. 7 , 8 , 9 , 10 , 11 , 12 , 13 Several groups have attempted to develop prediction tools for prosthetic candidacy, walking potential, or long-term prosthetic use. 13 , 14 , 15 , 16 , 17 Neither tool was specifically designed to predict outcomes for individuals with LLA who were being considered for inpatient rehabilitation.…”

Sociodemographic Determinants for the Health-Related Quality of Life of Patients with Vascular Amputations as Determined with the Prosthesis Evaluation Questionnaire

“…Amputation of the lower limb has a great impact on physical and psychological well-being, mobility (along with an increase in falls) [7], and on the life and social function of individuals [8]. Moreover, it produces emotional disturbances and an increased pain level.…”